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Fractures of the hand
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
X-rays in PA and lateral direction. Note the length of the radius, the radial inclination and volar tilting of the joint surface, intra-articular fractures of the radius or DRU joint, and any fracture of the ulnar styloid (TFC involvement). If indicated, take X-rays of the entire forearm. In case of a complex comminuted or intra-articular fractures, there may be an indication for a CT scan.
Treatment of distal intra-articular/extra-articular tibial fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Vasileios P. Giannoudis, Peter V. Giannoudis
Initial assessment of the patient should follow the advanced trauma life support (ATLS) guidelines. After initial resuscitation and exclusion/management of life-threatening injuries, a detailed neurovascular examination of the injured extremity must take place. The possibility of compartment syndrome should be excluded. The state of the skin should be assessed and documented clearly in the notes (degree of swelling, presence of blisters and/or open wounds) (Figure 28.1). The presence of deformity indicates substantial fracture displacement/dislocation and should be reduced promptly to allow resuscitation of the soft tissue envelope and reduction of the painful stimuli. A back slab must be applied for maintenance of reduction. Initial plain anteroposterior (AP), lateral, and mortice view radiographs of good quality are of paramount importance to appreciate the fracture pattern and the success of fracture reduction. In cases where there is clearly intra-articular fracture involvement, a computed tomography (CT) scan with three-dimensional (3D) reconstruction can assist further in depicting the fracture pattern (Figure 28.2).
Extremity trauma
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Absolute stability. Implies no displacement or movement and is achieved by accurate anatomical reduction with compression across the fracture fragments to optimise the environment for direct bone healing. This is desirable in intra-articular fractures, where callus at the fracture site might inhibit movement. Intra-articular fractures require an anatomical reduction and absolute stability.
The Effect of Kinesio Taping Versus Splint Techniques on Pain and Functional Scores in Children with Hand PIP Joint Sprain
Published in Journal of Investigative Surgery, 2020
Sancar Serbest, Uğur Tiftikci, Erdoğan Durgut, Özge Vergili, Cem Yalın Kılınc
Forty-nine pediatric patients who had presented to our orthopedics and traumatology polyclinic with PIP finger joint sprain injuries over the period 2014–2018 were included in the study. After a local ethics committee decision was obtained (21/07), a retrospective review of the files of the patients and subjects included in the study was carried out. Included in the study were pediatric patients between the ages of 7 and 16 with no known diseases of the muscles, tendons, or bones who had sustained PIP joint sprain injuries. Following a detailed radiological and clinical evaluation, patients over the age of 16 and below the age of 7 with intraarticular fractures, dislocation, other trauma, and those who had not completed their treatment and follow-ups were excluded from the study (Figure 1).
Intraoperative computed tomography with an integrated navigation system versus freehand technique under fluoroscopy in the treatment of intra-articular distal radius fractures
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Yasunori Kaneshiro, Noriaki Hidaka, Koichi Yano, Akira Kawabata, Makoto Fukuda, Ryuichi Sasaoka, Hideki Sakanaka, Kiyohito Takamatsu
In this study, at the postoperative evaluation, we found a significantly larger number of intraarticular and dorsal cortical screw penetrations in the group who underwent freehand fluoroscopy guided surgery compared with those who had CT navigated surgery. Furthermore, a larger intra-articular fracture gap was observed in the non-navigated group of patients. In VLP fixation of DRF, the reported incidence of intra-articular screw penetration has been reported between 6 and 11% [10,11]. While intra-articular screw penetration may cause cartilage damage and pain, excessively long screws which perforate the dorsal cortex may lead to irritation and finally rupture of extensor tendons [4,10,12]. On the other hand coronal split or displaced intra-articular fractures with a large dorsal fragment may require that screws engage the dorsal cortex [13]. As anticipated, articular and dorsal cortical penetration of screws was mainly observed in the non-navigated group. It emphasizes the difficulty of visualizing and evaluating exact screw positioning for complex type C3.1 DRF. This is further complicated by the irregular geometry of the distal radius as well as the splayed arrangement of the distal screws in VLP [14].
Treatment of Die-Punch Fractures with 3D Printing Technology
Published in Journal of Investigative Surgery, 2018
Chunhui Chen, Leyi Cai, Chuanxu Zhang, Jianshun Wang, Xiaoshan Guo, Yifei Zhou
Die-punch fractures were first reported by Scheck et al. in 1962 and occur when the dorsomedial fragment separates from the lunate fossa in the distal radius [1]. A die-punch fracture is now known as a special intra-articular fracture. Most of these fractures occur in young patients, and are caused by high-energy impaction to the lunate fossa after a fall from height or a vehicle, with subsequent collapse of the lunate fossa and apparent displacement in the distal radius articular surface [2, 3]. Most die-punch fracture fragments displace >2 mm and are commonly accompanied by multi-fragments in the articular surface, which present a great challenge for the surgeon [4]. In a study investigating outcomes of AO C3-type distal radius fractures, Earp et al. reported eight cases of postoperative loss of reduction, most (n = 5) of which involved the lunate fossa [5]. Similarly, Rozental et al. reported 41 dorsally displaced unstable fractures of the distal radius in which 50% (2/4) of the cases of reduction loss occurred in the lunate facet [6]. Modifying joint congruence as a step-off over 2 mm likely leads to symptomatic arthrosis in a large proportion of patients, with a reported incidence of 78–100% [7].